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A 2D Finite Element Model of a Medial Collateral Ligament Reconstruction
Published in J. Middleton, M. L. Jones, G. N. Pande, Computer Methods in Biomechanics & Biomedical Engineering – 2, 2020
R.M. Grassmann, N.G. Shrive, C.B. Frank
Ligament injuries are prevalent in North America, with an estimated 13.5% of the population between the ages of 18 to 35 being affected (Kelsey et al1). These injuries are typically handled in one of two ways: by conservative treatment, e.g. physiotherapy in the case of a MCL injury; or by reconstructive surgery which may be performed in cases of an anterior cruciate ligament (ACL) injury or triad injury (MCL, ACL and posterior cruciate ligament). For reconstructive surgery, graft tissue is often taken to replace the former ligamentous tissue. However, even with reconstructive surgery, the graft material never attains the mechanical properties of the former tissue.
Lower extremity injuries
Published in Youlian Hong, Roger Bartlett, Routledge Handbook of Biomechanics and Human Movement Science, 2008
William C. Whiting, Ronald F. Zernicke
Collateral ligament sprain: The knee, because of its poor bony fit, relies on ligaments for structural support. The primary ligaments are the cruciates (ACL and PCL) and the collateral ligaments, specifically the medial collateral ligament (MCL) and lateral collateral ligament (LCL). The MCL is a capsular ligament that connects the medial femoral epicondyle with the superomedial surface of the tibia. As a capsular ligament, the MCL has direct connection to the joint capsule and the medial meniscus. The LCL, in contrast, is extracapsular and connects the lateral epicondyle of the femur with the lateral surface of the fibular head.
General Thermography
Published in James Stewart Campbell, M. Nathaniel Mead, Human Medical Thermography, 2023
James Stewart Campbell, M. Nathaniel Mead
A common form of knee injury involves damage to the medial collateral ligament (MCL), which connects the medial condyle of the femur to the medial side of the upper tibia (Figure 10.74).190 An acute MCL tear is usually accompanied by pain, muscular guarding, swelling, and blood in the joint fluid. Careful evaluation and follow-up is needed when an MCL injury occurs because recurrence is possible if healing is not complete. Thermography provides an easy and noncontact assessment of joint morbidity.191
Influence of the forehand stance on knee biomechanics: Implications for potential injury risks in tennis players
Published in Journal of Sports Sciences, 2021
Caroline Martin, Anthony Sorel, Pierre Touzard, Benoit Bideau, Ronan Gaborit, Hugo DeGroot, Richard Kulpa
The main function of the MCL is to stabilize the medial side of the knee joint. Its role is very important for providing support against valgus stress, rotational forces, and anterior translational forces on the tibia (Andrews et al., 2017). In tennis, the MCL is the most commonly injured knee ligament (Renstrom & Lynch, 2002). The injury usually occurs during a twisting situation when the knee is forced into a valgus position with external rotation (Rattner et al., 2011). For example, it has been reported that MCL strain increases with the increase of knee abduction moment (between 2 and 115 N.m−1) in cadavers (Bates et al., 2019) and in a simulation study (Shin et al., 2009). Moreover, in ski accidents, it has been reported that the moments required to rupture the MCL were estimated at 92 N.m−1 for knee abduction moment and 123 N.m-1 for external moment through a simple model (Johnson et al., 1979). In our study, the results show that maximal knee abduction angle, peak of knee abduction and external rotation torques are significantly higher in DOS (16°, 230 N.m−1, 52 N.m−1, respectively). Moreover, the peak of knee medial force increases significantly in DOS. As a result, DOS seems riskier for MCL injuries.
Effects of medial collateral ligament release, limb correction, and soft tissue laxity on knee joint contact force distribution after medial opening wedge high tibial osteotomy: a computational study
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2019
Tserenchimed Purevsuren, Batbayar Khuyagbaatar, Kyungsoo Kim, Yoon Hyuk Kim
Medial opening wedge HTO usually re-tensions layers of the medial collateral ligament (MCL). Therefore, ligament release plays an important role in balancing the medial and lateral load distribution (Pape et al. 2006). Intra-operatively, the stretched MCL can be managed in several ways; it can be left intact (Fowler et al. 2012) or released partially or completely (Pape et al. 2006). There is no consistent method or recommendation for MCL release during HTO surgery, and experimental evidence is lacking. Only one cadaver study has evaluated the effect of MCL release in HTO on knee contact pressure (Agneskirchner et al. 2007). The authors concluded that medial opening wedge HTO can decompress the medial compartment only after complete release of the superficial MCL. Biomechanically, MCL injury can lead to knee joint instability, especially in varus-valgus rotation (Grood et al. 1981). Furthermore, collateral laxity is commonly associated with medial knee OA due to loss of cartilage and joint space narrowing in the degenerated medial side of the knee (Lewek et al. 2004). Therefore, a large amount of MCL release during HTO, in addition to pre-existing collateral laxity in the OA knee, can lead to post-operative valgus instability (Pape et al. 2006). Interestingly, MCL release can also influence limb alignment after HTO. One study measured the shift of mechanical axis in cadaveric weight-bearing simulation while the MCL was released sequentially (Kendoff et al. 2008). The authors found that complete sectioning of the MCL led to a significant shift of the axis, which can potentially change the desired limb correction. Therefore, the effects of MCL release during HTO on medial and lateral load distribution require investigation. In this study, we evaluated the effects of MCL laxity and loading axis correction on the medial-lateral contact force distribution after medial opening wedge HTO with different types of MCL release during simulated weight-bearing in order to provide quantitative evidence for determining the necessary MCL release strategy for balanced tibiofemoral load distribution after HTO.
Clinical versus MRI grading of the medial collateral ligament in acute knee injury
Published in Research in Sports Medicine, 2022
Jamie S Brown, Ola Olsson, Anders Isacsson, Martin Englund
The medial collateral ligament (MCL) is one of the most frequently injured knee ligaments (Olsson et al., 2016). Grade I and II injuries are generally managed non-surgically, whereas both surgical and non-surgical management have been documented with successful outcome in grade III injuries (Marchant et al., 2011; Smyth & Koh, 2015). A range of motion brace may be recommended particularly in higher grade injuries (Laprade & Wijdicks, 2012; Lundblad et al., 2019). Although examination by an experienced clinician has traditionally been the accepted standard for grading, the possibility of concomitant injury, most commonly the anterior cruciate ligament (ACL; Olsson et al., 2016), means MRI is often utilized after the initial clinical examination as part of the evaluation. The relationship between clinical and MRI findings with regard to the MCL is not well defined ,and there is a possibility that discrepancies in grading may lead to uncertainty about the degree of ligament injury present. Several previous studies have suggested questionable agreement between clinical and magnetic resonance imaging (MRI) grading (Mirowitz & Shu, 1994; Schweitzer et al., 1995; Yao et al., 1994). The studies by Mirowitz & Shu (Mirowitz & Shu, 1994) and Yao (Yao et al., 1994) are, however, both limited by relatively small sample sizes, and in addition, the latter studied a mix of both acute and chronic collateral ligament injuries. In a recent study of 130 elite professional athletes, investigators reported excellent agreement between clinical and MRI grading of MCL injuries (Lundblad et al., 2019). It is, though, uncertain whether findings from a group of high-level athletes and highly specialized team doctors are applicable outside of elite sport. Rasenberg et al. (1995) also demonstrated excellent agreement between MRI and clinical examination; however, their use of a varus/valgus testing device in a group of only 21 patients means their results may not be generalizable to a wider population. As such, uncertainty remains regarding the relationship between clinical and MRI grading of the MCL. The purpose of the present study was to investigate the agreement between clinical grading by an orthopaedic specialist and MRI grading of the MCL in a large cohort of patients presenting to a district general hospital with acute knee injury.